II. Definitions

  1. Constipation
    1. Derived from latin constipare (to crowd together)
    2. Difficult stool passage
      1. Sensation of incomplete evacuation
      2. Straining at stool
    3. Decreased stool frequency
      1. Normal frequency difficult to define
      2. In U.S., 95% of people pass >3 stools per week
        1. Therefore, 3 or less stools per week is defined as Constipation

III. Physiology

IV. Causes

  1. See Constipation Causes
  2. See Functional Constipation (most common cause)

V. History

  1. Stool History
    1. Consider Bristol Stool Scale to identify stool abnormalities
    2. Stool caliber
    3. Stool frequency
    4. Stool consistency
  2. Duration of Constipation
    1. Organic causes present as Acute Constipation
    2. Functional causes present as Chronic Constipation
  3. Age may direct causes
    1. Consider Hirschsprung's Disease in younger patients
    2. Consider Colorectal Cancer in older patients
  4. Medication History
    1. See Medication Causes of Constipation
    2. Laxative Abuse (Phenolphthalein, senna, castor)
  5. Habits
    1. Dietary Fiber intake
    2. Clear fluid intake per day
    3. Caffeine intake
    4. Physical Exercise
    5. Ignoring urge to defecate
  6. Abdominal surgery history
    1. Risk of intra-abdominal adhesions
  7. Red flags suggestive of Organic Constipation (requires Colonoscopy)
    1. Age over 50 years old and no prior Colorectal Cancer Screening
    2. Acute or recent onset Constipation
    3. Weight loss (especially more than 10 pounds or 4.5 kg)
    4. Abdominal Pain or cramping
    5. Rectal Bleeding, Melena, heme-positive stool (Iron Deficiency Anemia)
    6. Nausea or Vomiting
    7. Rectal Pain
    8. Fever
    9. Change in stool caliber

VI. Exam

  1. General Physical Exam
    1. Signs of Hypothyroidism (skin dry, edema, pallor)
    2. Neurologic Exam
  2. Abdominal Exam
    1. Abdominal Mass
    2. Bowel sounds (high-pitched or absent)
  3. Perianal changes
    1. Hemorrhoids
    2. Anal Fissures
    3. Anal stenosis or stricture
  4. Digital Rectal Exam!
    1. Fecal Occult Blood Testing
    2. Rectal Mass
    3. Amount and consistency of stool in Rectum
    4. Stool leakage on rectal exam
      1. Suggests Fecal Impaction or Rectal Prolapse
    5. Severe pain on Digital Rectal Exam
      1. Suggests Anal Fissure or Hemorrhoids
    6. Anal sphincter tone
      1. Poor sphincter tone suggests neurologic deficit
      2. Anal Wink loss suggests sacral nerve deficit

VII. Management

  1. No red flag symptoms or signs
    1. See Functional Constipation (Chronic Constipation)
    2. Treat empirically
    3. If no improvement consider Organic Constipation
  2. Red Flag symptoms or signs above suggest organic cause
    1. See Organic Constipation (Acute Constipation)

VIII. References

  1. Cheskin in Barker (1995) Ambulatory Medicine, p.476-81
  2. Sartor in Dornbrand (1992) Ambulatory Care, p. 221-5
  3. Arce (2002) Am Fam Physician 65(11):2283-90 [PubMed]
  4. Borum (2001) Prim Care 28(3):577-90 [PubMed]
  5. Wald (2000) Med Clin North Am 84(5):1231-46 [PubMed]

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Related Studies

Ontology: Constipation (C0009806)

Definition (CCC) Impression of infrequent or difficult passage of hard, dry feces without cause
Definition (CCC) Difficult passage of hard, dry, feces
Definition (MEDLINEPLUS)

Constipation means that a person has three or fewer bowel movements in a week. The stool can be hard and dry. Sometimes it is painful to pass. At one time or another, almost everyone gets constipated. In most cases, it lasts a short time and is not serious.

There are many things you can do to prevent constipation. They include

  • Eating more fruits, vegetables and grains, which are high in fiber
  • Drinking plenty of water and other liquids
  • Getting enough exercise
  • Taking time to have a bowel movement when you need to
  • Using laxatives only if your doctor says you should
  • Asking your doctor if medicines you take may cause constipation

It's not important that you have a bowel movement every day. If your bowel habits change, however, check with your doctor.

NIH: National Institute of Diabetes and Digestive and Kidney Diseases

Definition (NCI) Irregular and infrequent or difficult evacuation of the bowels.
Definition (NCI_CTCAE) A disorder characterized by irregular and infrequent or difficult evacuation of the bowels.
Definition (NCI_NCI-GLOSS) A condition in which stool becomes hard, dry, and difficult to pass, and bowel movements don't happen very often. Other symptoms may include painful bowel movements, and feeling bloated, uncomfortable, and sluggish.
Definition (NAN) Self-diagnosis of constipation and abuse of laxatives, enemas, and suppositories to ensure a daily bowel movement
Definition (NAN) Decrease in normal frequency of defecation accompanied by difficult or incomplete passage of stool and/or passage of excessively hard, dry stool
Definition (CSP) condition in which bowel movements are infrequent or incomplete.
Definition (MSH) Infrequent or difficult evacuation of FECES. These symptoms are associated with a variety of causes, including low DIETARY FIBER intake, emotional or nervous disturbances, systemic and structural disorders, drug-induced aggravation, and infections.
Concepts Sign or Symptom (T184)
MSH D003248
ICD9 564.00, 564.0
ICD10 K59.0 , K59.00
SnomedCT 162080004, 363693003, 162083002, 197123003, 139356000, 139359007, 139358004, 162082007, 14760008, 129585003
LNC MTHU013416, MTHU013456, MTHU020768
French CONSTIPATION, Constipation
Portuguese Constipação Intestinal, OBSTIPACAO, Obstipação, Prisão de Ventre
Swedish Förstoppning
Japanese ベンピ, 便秘症, 便秘
Czech obstipace, zácpa, Zácpa
Spanish constipación subjetiva, constipación, SAI (trastorno), ESTRENIMIENTO, constipación, SAI, estreñimiento, SAI (hallazgo), estreñimiento, SAI, estreñimiento, SAI (trastorno), dificultad para evacuar el intestino, constipación (hallazgo), constipación, SAI (hallazgo), Constipation NOS, Constipación de Vientre, constipación, estreñimiento (trastorno), estreñimiento subjetivo (trastorno), estreñimiento subjetivo, estreñimiento, Estreñimiento
Finnish Ummetus
English constipation (diagnosis), constipation, constipation (symptom), Constipation NOS, Constipation, unspecified, Constipation [Disease/Finding], rndx unspecified constipation (diagnosis), rndx perceived constipation, rndx unspecified constipation, rndx perceived constipation (diagnosis), constipating, constipated, constipate, difficulty defecating, Constipation symptom, Constipation (& symptom), Constipation (& symptom) (finding), Constipation NOS (finding), Constipation (finding), Costive symptom, Constipation NOS (disorder), Unspecified constipation, CONSTIPATION, Perceived Constipation, Unspecified Constipation, Perceived constipation, Constipation (disorder), Costiveness, Perceived constipation (disorder), Difficult passing motion, Difficulty defaecating, Difficulty defecating, Difficulty opening bowels, Difficulty passing stool, CN - Constipation, Constipated, PERCEIVED CONSTIPATION, fecal; retention, retention; fecal, Constipation
German VERSTOPFUNG, Obstipation, Verstopfung
Korean 변비
Italian Costipazione, Stipsi
Polish Zaparcie
Hungarian Obstipatio
Norwegian Forstoppelse, Treg mage, Hard avføring, Obstipasjon
Dutch faeces; retentie, retentie; faeces, constipatie, Obstipatie, Constipatie